<div class="detaiTab">
<form action="/depositRest/depositBzjSubmit" class="action-ajax-form action-ajax-form-valid" method="POST"/>
	  <table style="text-align:center;" width="100%"  >
	  <tr>
	     <td>
		<span class="action-form-field-group">
	           <span class="fm-input">
	          	   <label><span style="color:red">*</span>退还保证金金额:</label><input type="text" name="backMargin" class="inputNum form-control" value=""
								id="backMargin"><span style="color:red" class="action-field-error" for="backMargin"></span>
	           </span>
	    </span>
	    </td>
	    
	     <td>
		<span class="action-form-field-group">
	           <span class="fm-input">
	          	   <label><span style="color:red">*</span>要求打款时间:</label><@date class="form-control" id="repaymentDate" value="" name="repaymentDate"/>
	           </span><span style="color:red" class="action-field-error" for="repaymentDate"></span>
	    </span>
	    </td>
	    </tr>
	    <tr>
	       <td>
		<span class="action-form-field-group">
	           <span class="fm-input">
	          	   <label><span style="color:red">*</span>退还账户户名:</label> <input type="text" name="accountName" class="inputNum form-control" value=""
								id="accountName">
	           </span><span style="color:red" class="action-field-error" for="accountName"></span>
	    </span>
	    </td>
	       <td>
		<span class="action-form-field-group">
	           <span class="fm-input">
	          	   <label><span style="color:red">*</span>&nbsp;卡&nbsp;&nbsp;号:&nbsp;</label> <input type="text" name="bankAccount" class="form-control" value=""
								id="bankAccount">
	           </span>
	           <span style="color:red" class="action-field-error" for="bankAccount"></span>
	    </span>
	    </td>
	    </tr>
	    <tr>
	        <td>
		<span class="action-form-field-group">
	           <span class="fm-input">
	          	   <label><span style="color:red">*</span>&nbsp;开户银行:&nbsp;</label> <input type="text" name="bankName" class="form-control" value=""
								id="bankName">
	           </span>
	           <span style="color:red" class="action-field-error" for="bankName"></span>
	    </span>
	    </td>
	       <td>
		<span class="action-form-field-group">
	           <span class="fm-input">
	          	   <label><span style="color:red">*</span>&nbsp;开户支行:&nbsp;</label> <input type="text" name="bankAddr" class="form-control" value=""
								id="bankAddr">
	           </span>
	            <span style="color:red" class="action-field-error" for="bankAddr"></span>
	    </span>
	    </td>
	    </tr>
	    	    <tr>
	        <td>
		<span class="action-form-field-group">
	           <span class="fm-input">
	          	   <label>&nbsp;转账备注:&nbsp;</label> <input type="text" name="repaymentNotes" class="form-control" value=""
								id="repaymentNotes">
	           </span>
	    </span>
	    </td>
	    </tr>
	 </table>
	    <span>
           <input type="submit" value="保存" class="btn_auto_30 btn_blue" />&nbsp;&nbsp;
        </span>
	</form>
</div>